Pre-Billing Compliance Specialist/Home Health & Hospice Coder - Orange, CT

Pre-Billing Compliance Specialist and a Home Health/Hospice Coder (PRN)

REMOTE POSITION!!! (Eastern or Central Time Zones)

Job Description

This position is a dual full-time exempt role as a Pre-Billing Compliance Specialist and a Home Health/Hospice Coder (PRN). The Pre-Billing Compliance Specialist responsibilities include assisting in providing oversight and education to administrators, directors, and clinical personnel enterprise wide to ensure excellent clinical practices, documentation, and financial integrity and success of the organization. The Home Health/Hospice Coder is responsible for accurately coding patient medical records and claims for home health and hospice services. This role ensures compliance with coding guidelines, assists in proper billing, and contributes to the efficiency of the healthcare facility’s financial operations.

Essential Job Responsibilities

Pre-Billing Specialist

1. Assesses, develops, implements, and evaluates financial compliance practices at the program level.

2. Instructs administrators, directors, and clinical staff on best practices for clinical and financial compliance.

3. Participates in quarterly reviews and audits.

4. Instructs and trains staff as needed related to billing compliance.

5. Promotes continuous quality improvement by systematically monitoring and evaluating the efficiency and effectiveness of documentation practices and compliance to regulatory requirements.

6. Oversees and assists in the identification of performance improvement and compliance for improved financial stability.

7. Establishes a uniform method for data collection and trending on an ongoing basis with a focus on documentation, compliance, and financial integrity.

8. Coordinates and monitors high-risk compliance related activities.

9. Conducts hospice/home health billing/chart reviews to ensure adherence to State and

Federal regulatory requirements and/or standards.

10. Works closely with Revenue Cycle and other departments to proactively monitor internal controls to manage, detect, and mitigate billing compliance risks.

11. Participate in committees, workgroups and projects to collaborate on billing compliance matters and best practice strategies.

12. Communicates laws, rules, policies, standards, and expectations to employees on a regular basis and provides training, as needed.

Home Health/Hospice Coder

1. Review clinical documentation from home health and hospice providers to accurately assign appropriate ICD-10, CPT, and HCPCS codes for diagnoses, treatments, and procedures.

2. Maintain knowledge of coding regulations and guidelines (such as ICD-10, HCPCS Level II, and CMS rules), ensuring all codes are compliant with local, state, and federal policies, including Medicare and Medicaid requirements.

3. Perform chart reviews to verify that all services, diagnoses, and treatments are properly documented and coded, ensuring that all necessary information is included for accurate billing.

4. Work to resolve any coding discrepancies or claim rejections.

5. Generate coding reports and track coding metrics.

Although each position has its own unique duties and responsibilities, the following applies to all employees of Constellation Health Services LLC:

All employees will:

• Exercise necessary cost control measures
• Strive to provide and maintain positive external and internal customer service and promote a culture of excellence in customer service.
• Must demonstrate effective communication skills by convening necessary information accurately, listening effectively and asking questions when clarification is needed.
• Must be dependent upon to plan and organize work effectively and ensure its completion.
• Must be able to demonstrate reliability by arriving at work on time and taking breaks in the expected time frames.
• Will be expected to meet all productivity requirements.
• Must be a